November 23, 2016

November 23rd, 2016 did not go as planned, but was so much more than what I had expected. I was a nervous and excited wreck when I arrived in the conference room at 6:45AM. I was finally able to calm down, when a doctor comes in and asks if I were here for the morning conference. I answered with a yes and was about to do the whole OREX student spiel because I thought he was suspicious of me. However, he told me that the meeting was replaced with a larger conference in some classroom and he did not know where or what room number it was, so I ran out of the room with five minutes left until it the stroke of 7. I vaguely recalled my Highland volunteer orientation two years ago, which was held in the only classroom I knew of at Highland. Luckily, I was right and managed to find the room in time before I interrupted Dr. James Betts from Children’s Hospital as he began his lecture on pediatric trauma and emergency care. I had expected twenty people tops, but there were the usual residents and interns, as well as Children’s staff and Highland applicants. By the time I found a seat, my heart was racing and my hands were shaking as I lifted my coffee to my lips. Dr. Betts discussed the general protocol and procedures in pediatric care and shared many heartbreaking and encouraging cases. It was inspiring how dedicated he is to his work.

After the lecture finished, I located Dr. Harken from a distance, but some medical students or applicants beat me to him. It was also already 8:30, so I made my way to the OR by myself. I was a bit disoriented and since I was already sticking out like a sore thumb, I just asked people in the hallway where things were and was able to successfully change into scrubs. And with my luck of course, all of the surgeries on the whiteboard were scheduled for 8AM. I was a little bummed and lost. As I made my way to pre-op and post-op to search for something to do, charge nurse Nathan spots me and was very nice in asking me who I was. He then brings me to OR 3 and introduces me to the staff. It was a colostomy takedown performed by Dr. Bullard (I believe) and Dr. Gupta. I was quite nervous, but Dr. Gupta was playing music and ‘No Scrubs’ by TLC came on and it was very fitting and just perfect.

I missed the first part of the surgery, when they opened up the artificial opening for the colostomy bag. One of the nurses, Romal was very chatty, welcoming, and willing to answer any questions I had. They began opening up the patient’s abdomen. “The Lamborghini of retractor sets”, which referred to a gold self-retaining retractor set that attached to a bedpost, was brought in and set up to hold open the abdomen. I wasn’t the biggest fan of the contraption, as it was blocking my view of the anatomy. Romal thoughtfully asked if I wanted to observe a more interesting surgery multiple times, but I politely declined as I did not want to interrupt another surgery and I already thought this surgery was very interesting, since it was my first surgery ever. After an hour or two of abdomen work, Dr. Gupta repositioned to the patient’s anus and prepped to use an endoscopic curved intraluminal stapler, which she referred to as “the most stressful part of the case”. During this brief transition, Dr. Bullard was super nice and walked over to me to introduce herself personally. I stuck my hand out to shake her hand, but quickly pulled back as I realized I was not sterile. Dr. Gupta then inserted the stapler into the patient’s anus and with very precise coordination with Dr. Bullard, who viewed the instrument from the abdomen, the staple reconnected the intestines. Dr. Bullard then calls me over to the operating table to take a look. In my head, I was screaming to myself repeatedly, “DO NOT FACE PLANT INTO THIS MAN’S JEJUNUM” (not quite sure why specifically the jejunum). I’m sure everyone else thought I was way too close to the sterile blue; the scrub tech told me to take off my badge and Romal was even pulling back my oversized scrub sleeve, but Dr. Bullard told me to get even closer, so I wasn’t going to say no. She pointed out some of the anatomy and the staple in the distal sigmoid colon. The only abdominal anatomy I had seen prior to this was in a two year old cadaver. It was really amazing to compare and apply what I had learned before to a live human body. They ended up having to redo the staple because it was not completely sealed, then they closed the abdomen and removed remnants of the ostomy from the colostomy opening.

The first surgery wrapped up around 12:45PM. Scrub tech Ana Maria asked if she could show me around the department. It was a great relief as there were no other surgeries scheduled until 2PM (I should have actually used this time for lunch, but I got too excited). She told me about her occupation as a contract technician and taught me about all the protocols, procedures, and many many instruments used during and in preparation for different surgeries. We took a quick break for some water, then I helped her prep for another rectal case. The patient came in just on time and was in a lot of pain. I really wished to help comfort him, but he only really understood Spanish. As they positioned him and his groin area was exposed, so was the most vile smell. Nurse Romal was a lifesaver and put toothpaste on our face masks.

Dr. Gupta led a group of residents in an EUA (exam under anesthesia) and perineal debridement. They reassured me that this case was not normal and was exceptionally bad. The patient had a necrotic rectal cancer as well as a crazy infection. I was asking myself what I was looking at; his anatomy was quite disfigured. Under his scrotum, were two openings (yes, two) with greenish-grey “stuff” coming out of them along with some blood and below that, a baseball-sized mass in his gluteal cleft. It was quite the sight. Dr. Gupta started just feeling around, and pieces of dead flesh just fell right off. The doctors were aware that it was impossible for them to extract all of the cancer, so they aimed to clear out as much of the infection as possible for the comfort of the patient. The procedure was much quicker and less precise than the previous operation. The doctors simply cranked up the Bovie to maximum power, cauterized everything, and extracted anything that was dead or infected. I was amazed by Dr. Gupta and the other residents and how they got down and dirty, literally. All the other staff were barely able to handle the smell, let alone having the cancer be a foot away from their face. When the doctors were finished, the two holes were opened to form one large hole and it was large enough to easily fit my fist in to. Urologist Dr. Blaschko then used a Cystoscope (small camera on a thin tube that is inserted into the urethra) to visualize the inside of the bladder. It was expected that the patient with such an extreme form of rectal cancer would show signs of bladder cancer; however, the cystoscope was nondiagnostic and “suspicious”. They dressed him in a wet dressing and some mesh underwear before sending him to the ICU. Unfortunately, ICU beds were also all full, so he was sent to the PACU for close observation.

My terrible ankles were dying by 4:30PM, so I thanked all the staff for their kindness throughout the day as they left for the PACU and excused myself. Ana Maria and I further discussed how crazy the last surgery was and she shared some of her other extreme cases, as we got ready to leave together. She was so very kind and even thanked me for letting her show me around, when she was the true lifesaver. She also told me to tell all of you that if you want someone to show you around, just ask for Ana Maria!

As I stepped out of the hospital, I noticed that the sun was setting and the sky was about the same shade as when I arrived in the morning. I realized that most of the doctors inside probably missed all of the daylight. Their energy and resilience are incredible. I was just standing and I was exhausted. I am glad how everything went on my first day and I can’t wait for what else I will experience this next year!